An expat’s guide to accessing public and private healthcare in France

Expats looking for healthcare in France will no doubt benefit from the modern healthcare facilities available in this country. Considered one of the most medically advanced countries in the world, France is reputed for its revolutionary medical research. For example, in 2008, virologist Luc Montagnier won the Nobel prize for his research in isolating HIV, the disease that causes AIDS.

France is also renown for being one of the largest producers of pharmaceutical products in Europe. Pharmaceutical regulations are also relatively relaxed in France, and as such consumption of pharmaceutical products is considerably higher here compared to other European countries.

There are a few things that expats in France should know about receiving treatment in public and private hospitals, and the health insurance options available.

We asked our friends at Pacific Prime to help with this informative article on accessing both types of healthcare.

Background on healthcare in France

France enjoys one of the leading healthcare systems in the world, thanks to its combination of universal health coverage (known as CMU, more on this below) and high supply of healthcare providers (there are 3 doctors per 1,000 population in the country).

The overall state of health in the country has a positive outlook, especially when looking at the average life expectancy at birth, which is over 82.4 years - 1.8 years higher than the EU average of 80.6). Women in France have the highest life expectancy in the world, with an average 85.6 years.

Medical doctors are highly trained, and many French residents enjoy high standards of service in both public and private sector facilities. However, expats should be aware that not all doctors will speak English, especially in rural parts of the country, so learning some useful health-related vocabulary can really come in handy. It is also worth requesting a list of doctors who speak English in your area from your embassy or consulate.

Hospitals in France are either state-run public hospitals or privately run. You’re required to show your health insurance card (carte vitale) so that you can you can prove whether you’re entitled to reimbursements for medical treatment. Alternatively, EEA citizens can present their European Health Insurance Card (EHIC), but this does come with many limitations (more on this below).

If you’re admitted into hospital for an emergency and do not have health insurance, you won’t be denied treatment but you’ll have to pay for the fees up front - this can be very expensive, depending on the procedure in question.

Expats and the French national health insurance system

To be compensated for most of your medical fees, expats are highly advised to apply for the French national health insurance scheme, named Couverture Maladie Universelle (CMU). Expats working in France with the intent on residing in France for over 183 days in a year are required to pay a CMU levy of around 6-7% of your income, as governed by French law.

Self-employed individuals can refer to the Regime Social des Indépendants website for information on CMU contributions and reimbursements. Those with a household income below a certain threshold are entitled to free coverage, this scheme is referred to as CMU-C. To register for French healthcare, simply visit your local CPAM (Caisse Primaire Assurance Maladie) office.

The CMU doesn’t pay for everything.

What’s good about the CMU scheme is that it covers pre-existing conditions. On the other hand, the CMU does not provide compensation for all of your medical treatment costs, as it will only pay for around 80% of fees. This percentage of fees is based on what the CMU guidelines state a procedure should cost, but not the actual cost charge. This means that you will need to pay the rest, and this can amount to a lot.

For treatment in hospitals, there are additional charges (called dépassements) that you will also have to pay. This could include things like private rooms, bedding charges, and food, which will not be covered. There will also be a daily charge of €18. Forking out for dépassements charges can cause a significant drain to your finances, when considering that there has been a recently reported case of someone paying €1,000 for a 2 day hospital stay, even though they are covered by CMU.

What about medicine?

Depending on the necessity of your medication, the CMU will pay either the total cost of your medication, 65%, 30%, 15% or nothing at all. For example, essential medication such as insulin will be deemed as completely necessary, so this will be 100% compensated.

If your medication is considered important, 65% will be reimbursed. Some medicines such as contraceptive pills, and medicines deemed as ineffective will not be reimbursed. It’s not uncommon to pay over €100 for medication.

As you can see, the French national health insurance scheme does not pay for everything, and many expats will choose to supplement these costs with an additional health insurance policy.

Public healthcare

There are three main categories of State-run hôpitaux in France, these include:

● Hospital centres/short-stay hospitals (hôpital de court séjou): This category includes general hospitals, specialist hospitals, regional hospitals and Assistance Publique hospitals linked with the University of Paris.

● Medium-stay hospitals (centre de moyen séjour): People who are treated in medium-stay hospitals are usually transferred from short-stay hospitals, for medical care such as physiotherapy, mental health treatment, and rehabilitation.

● Long-stay hospitals (centre et unité de long séjour): Long-stay hospitals are dedicated to people who can no longer take care of themselves on their own, such as elderly care in nursing homes.

Acute, short-term care for severe injuries or illnesses is primarily provided by public hospitals in France, and these facilities offer a broad range of surgeries - more so than in private hospitals. Not every hospital will have an A&E department, so it’s important that you check where all the available A&E departments are near you.

Please also keep in mind that hospitals in rural areas of France (usually hospital centres) will not be as well equipped, and medical staff in these facilities will likely not speak English. Many expats who do not speak any French (or only speak basic French) will prefer seeking treatment in private facilities, as most medical staff will speak English.

Private healthcare

Most private profit-making hospitals and clinics will offer specialized services for people who need more specialized care, as these treatments are usually where the profit opportunities lie. This may include a vast array of specialized treatment, such as specialist dermatological care, surgical or orthodontic procedures, and invasive procedures such as endoscopy. Very few private hospitals in France operate entirely out of the public sector, so these facilities are usually as openly accessible as public hospitals.

Many people go to private facilities for outpatient treatment, as not many private facilities operate as full-service hospitals in France, with the exception of a few, one of them being the world renown American Hospital of Paris founded by American expats. Another famous private hospital for expats in Paris is the Hertford British Hospital.

Private hospitals tend to impose higher additional charges, and while most private hospital fees are reimbursable through the French social security system, the remaining percentage (generally a 20% copayment) that you will have to pay can become exorbitant if you do not secure additional health insurance. Additionally, specialists will also charge a higher rate, and if you go directly to them without first receiving a referral from a French doctor, you will only be reimbursed a general doctor’s rate, and not the specialist’s rate.

Health insurance options available to expats.

Now, let’s take a look at the health insurance options commonly secured by expats in France.

The EHIC for EEA citizens only

With a European Health Insurance Card (EHIC), which is available for EEA citizens only, you will be able to receive free or discounted access to public health care when visiting a country within the EEA. If you’re going to be living in France, it’s definitely not enough to only be covered by the EHIC, as there are a number of costs that the EHIC does not cover for, including:

● Repatriation and rescue services

● Treatment in private hospitals that are not registered to provide state healthcare

● 24/7 support services typically provided by health insurance

● Accommodation you have lost as a result of being in hospital

Regardless of whether you’re eligible for an EHIC or not, expats are highly recommended to secure private health insurance to supplement their healthcare costs.

Private health insurance.

In most cases, universal health coverage does not cover 100% of treatment costs, so to avoid paying a mountain of additional fees, some expats and local citizens alike are purchasing additional private health insurance for peace of mind. Of course, there are many types of health insurance available, and your ideal plan will depend on your specific circumstances and requirements.

For example, if you rarely visit your GP and only require hospitalization coverage, you can purchase an inpatient-only plan to enjoy relatively cheaper premiums as opposed to plans that include both inpatient and outpatient plans. If you require additional coverage, such as maternity or dental cover, you can purchase a more comprehensive plan which includes both inpatient and outpatient coverage, as well as the additional coverage benefit(s) you require.

You’ll also need to decide on either choosing local health insurance or international health insurance:

● Local health insurance: As the name suggests, local health insurance covers you in one region only, meaning that once you leave France, you will no longer by eligible for making any claims on treatment received outside of the country. People with this type of policy will usually purchase additional travel insurance when travelling outside of their plan’s covered region. This type of plan is ideal if you rarely travel or if you’re on a tight budget, as premiums charged for this policy will be lower than for international plans.

● International health insurance: This type of insurance is specifically designed for globally mobile expats, meaning that you’ll have peace of mind from knowing that you will be covered no matter where you go, whether you’re away for business or for pleasure. With global coverage, you won’t have to worry about purchasing additional travel policies when travelling abroad. Please keep in mind that as there are significantly more regions are covered by international health insurance, the premiums that you will have to pay will be higher.

It can be confusing looking for additional health insurance to supplement your healthcare costs in France, so if you require some further advice and guidance, it can pay to talk to an insurance advisor to find the best value deal that is tailored to your specific needs.

About the author.

If you are looking for the best health insurance plans on the market, why not visit Pacific Prime, a global insurance broker. Their team of experienced insurance advisors can offer a wealth of experience that you can rely on.

Disclaimer:The opinions expressed here by Pacific Prime are their own, not those of Expats Paris.